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JUDITH T. TERRY 4t.
. Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER /arp Fax (516) 765-1823
494, 4re'r
Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 661 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECON I C CESSPOOL
Address 1 : P. O. BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
INSTALLATION OF ONE NEW OVERFLOW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. HOLD 10' BETWEEN POOLS. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner TRENTALANGE, MARY
Mailing Address 1 1400 STILLWATER AVENUE
City St Zip CUTCHOGUE NY 11935
Property Address 1 1400 STILLWATER AVENUE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 103.00 block 7 lot 9.000
Cross Street WILLOW STREET
Building Permit Number Cross Reference:
Issue Date: 11/16/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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a ' 4' A " - Town Hall, 53095 Main Road
_ + crA-r P.O. Box 1179
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JUDITH T. TERRY 1'"'''Fo-- TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERKgo
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TOWN OF SOUTHOLDlb ig ° l 4`;
October 29, 1990 P\
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To: Southold Town Code Enforcement 'Officer at-� Gwgr ' f
TOWN oFsn ll;'t aC F D x
From: Linda J. Cooper, Southold Town Clerk's Office a -K
Transmitted herewith is a copy of application No. A676 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Mary Trentalange •
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - i
DISAPPROVE -
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COMMENTS: QL ,9 0, qc
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Signature
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OI'FiCE OF THE TOWN CLERK ,., • '•..,
Town of Southold .i'al �VUL
Judith T. Terry, Town Clerk �' �� K�OI/ Application No.
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Town Hall, 53095 Main Road Z l Construction•
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P. O. Box 1179 _ • Alteration (
Southold, New York 11971 IP =_ j z.. //
'sb �' es 10.00 - Residential
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Telephone , > •10 $
(516) 765-1801 �l 411��VP. $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TAMC or CESSPOOL
Permit No.
Fee .$
DATE llttl
APPLICANT NAME:
APPLICANT ADDRESS:
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: /,�,/j ✓Ii _
OWNER MAILING ADDRESS: /
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: ,-- Far
TAX MAP NO. : Section /3 Block Lot 9
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:,
44141/714/
Signature of Applic nt
RECEIVED -BY: RECE ®
--Osier 's Office
DATE:
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